John Papadopoulos David R. Schwartz Consulting Editor. Pocket Guide to Critical Care Pharmacotherapy Second Edition

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2 John Papadopoulos David R. Schwartz Consulting Editor Pocket Guide to Critical Care Pharmacotherapy Second Edition 123

3 Pocket Guide to Critical Care Pharmacotherapy

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5 John Papadopoulos Author David R. Schwartz Consulting Editor Pocket Guide to Critical Care Pharmacotherapy Second Edition

6 Author John Papadopoulos, B.S., Pharm.D., FCCM, BCNSP Department of Pharmacy New York University Langone Medical Center New York, NY, USA Consulting Editor David R. Schwartz, M.D. Pulmonary and Critical Care Division Department of Medicine New York University Langone Medical Center New York, NY, USA ISBN ISBN (ebook) DOI / Springer New York Heidelberg Dordrecht London Library of Congress Control Number: Springer Science+Business Media New York 2008, 2015 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied specifically for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher s location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (

7 This handbook is dedicated to my wife, Maria, my children, Theodore Thomas, Eleni Thalia, and Pantelia Lia Zoe, and my mother, Eleni. I am grateful for your collective understanding of my professional commitment. John Papadopoulos

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9 Preface Critical care medicine is a cutting-edge medical field that is highly evidence-based. Studies are continuously published that alter the approach to patient care. As a critical care clinician, I am aware of the tremendous commitment required to provide optimal evidence-based care. Pocket Guide to Critical Care Pharmacotherapy covers the most common ailments observed in critically ill adult patients. I utilize an algorithmic, easy-to-follow, systematic approach. Additionally, I provide references and web links for many disease states, for clinicians who want to review the available literature in greater detail. The contents of this handbook should be utilized as a guide and in addition to sound clinical judgment. Consult full prescribing information and take into consideration each drug s pharmacokinetic profile, contraindications, warnings, precautions, adverse reactions, potential drug interactions, and monitoring parameters before use. Every effort was made to ensure the accuracy of Pocket Guide to Critical Care Pharmacotherapy. The author, consulting editor, and publisher are not responsible for errors or omissions or for any consequences associated with the utilization of the contents of this handbook. New York, NY, USA John Papadopoulos, BS, PharmD, FCCM, BCNSP vii

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11 Contents 1 Advance Cardiac Life Support Cardiovascular Cerebrovascular Critical Care Dermatology Endocrinology Gastrointestinal Hematology Infectious Diseases Neurology Nutrition Psychiatric Disorders Pulmonary Renal Index ix

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13 List of Tables Table 1.1 ACLS pulseless arrest algorithm... 1 Table 1.2 Ventricular fibrillation/pulseless ventricular tachycardia algorithm... 2 Table 1.3 Pulseless electrical activity algorithm... 3 Table 1.4 Asystole algorithm... 3 Table 1.5 Bradycardia algorithm (slow [heart rate < 50/min] or relatively slow)... 4 Table 1.6 Tachycardia algorithm overview (heart rate > 100/min)... 4 Table 1.7 Management of stable atrial fibrillation/atrial flutter... 5 Table 1.8 Management of narrow complex stable supraventricular tachycardia (QRS < 0.12 s)... 7 Table 1.9 Management of stable ventricular tachycardia... 8 Table 1.10 Synchronized cardioversion algorithm for the management of symptomatic tachycardia... 9 Table 1.11 Common drugs utilized during ACLS Table 1.12 Pulseless electrical activity: causes (HATCH H 2 MO pph) and management Table 1.13 Pharmacological management of anaphylaxis/anaphylactoid reactions xi

14 xii List of Tables Table 2.1 Thrombolysis in myocardial infarction (TIMI) grade flows Table 2.2 TIMI risk score for STEMI Table 2.3 Acute pharmacological management of unstable angina and non-st elevation myocardial infarction with an initial invasive angiographic strategy Table 2.4 Acute pharmacological management of ST-elevation myocardial infarction (noninvasive or conservative strategy) Table 2.5 Considerations in patients with right ventricular infarctions Table 2.6 Contraindications to fibrinolytic therapy in patients with ST-elevation myocardial infarction Table 2.7 Management of acute decompensated heart failure Table 2.8 Vaughan Williams classification of antiarrhythmics Table 2.9 Antithrombotic pharmacotherapy for patients with new onset atrial fibrillation Table 2.10 Causes and management of acquired torsades de pointes Table 2.11 Hypertensive crises Table 2.12 Management of catecholamine/ vasopressin extravasation Table 2.13 Prevention of venous thromboembolism in the medical intensive care unit patient Table 2.14 Acute management of a deep-vein thrombosis or pulmonary embolism Table 2.15 Management of an elevated international normalized ratio (INR) in patients receiving warfarin pharmacotherapy... 48

15 List of Tables xiii Table 3.1 General supportive care for patients with an acute cerebrovascular accident Table 3.2 Blood pressure management in the setting of an acute cerebrovascular accident Table 3.3 Alteplase inclusion and exclusion criteria for cerebrovascular accident indication Table 3.4 Modified National Institute of Health Stroke Scale Table 3.5 Alteplase administration protocol for cerebrovascular accident indication Table 3.6 Management of an alteplase-induced intracranial hemorrhage Table 3.7 Management of intracranial hypertension (intracranial pressure 20 mmhg) Table 4.1 General drug utilization principles in intensive care Table 4.2 Management of severe sepsis and septic shock Table 4.3 Pain, agitation, and delirium guidelines Table 4.4 Riker sedation-agitation scale Table 4.5 Confusion assessment method for the diagnosis of delirium in intensive care unit patients Table 4.6 Neuromuscular blocker use in the intensive care unit Table 4.7 Reversal of nondepolarizing neuromuscular blockers Table 4.8 Factors that alter the effects of neuromuscular blockers Table 4.9 Management of malignant hyperthermia Table 4.10 Use of packed red blood cell transfusions in critically ill patients... 72